儿童陈旧性孟氏骨折的手术治疗

目的:通过研究火器伤所致骨折患者的治疗及预后情况,探讨如何选择合理方法对其进行及时有效的治疗。方法:对25例火器伤所致骨折患者的治疗及预后情况进行回顾性总结分析,其中男18例,女7例;平均年龄36.2岁。骨折的部位为股骨骨折9例,胫骨骨折7例,肱骨骨折2例,骨盆骨折2例,锁骨骨折1例,椎体骨折1例,尺、桡骨骨折1例,髋关节骨折1例与膝关节损伤1例。骨折类型为未移位1例,移位2例,粉碎性10例,粉碎且移位6例,骨缺损6例。19例接受了骨科手术治疗,其他6例接受了清创治疗。10例采用外固定架固定,7例行内固定,4例行管形石膏固定,2例骨盆与髋臼骨折采用牵引治疗,2例锁骨骨折应用锁骨带治疗。结果:25例患者获得了平均4.2年的随访,18例骨折Ⅰ期愈合,6例需后期手术促进骨折愈合,1例截肢。有5例需要后期手术覆盖创面。大的并发症包括2例骨不连,4例延迟愈合,3例周围神经功能受损。结论:骨折固定方法的选择与骨移植是治疗火器伤所致的骨折与骨缺损的一项很有效的方法。     

Risk-Taking among Adolescents Who Say They Can Get a Handgun

In a survey of 5657 community-residing adolescents, those who said they could get a handgun in two days reported similar and those who said they could not get a handgun reported fewer risk behaviors and less violence perpetration and victimization than adolescents who have their own handgun. Adolescents who said they could get a handgun reported more exposure to and experience with firearms than those who said they could not get a handgun. Risk reduction efforts regarding adolescents should be expanded to include adolescents who say they can get a handgun.     

Gunshot wounds: A review of ballistics related to penetrating trauma

Civilian gunshot injuries from handgun and rifle ammunition vary in severity depending on the anatomic location involved and the different effects from the ballistic properties of the penetrating projectiles. Ballistic factors such as the impact velocity and energy should not be considered in isolation, as their specific effects are determined by the interaction between the projectile and tissues. Increased tissue damage can result from tumbling of non-deforming rifle bullets and deformation of expanding bullets. Both of these mechanisms increase substantially the energy transfer to the wound and its diameter, also producing a pulsating temporary cavity associated with pressure changes within tissue.     

The associations between state veteran population rates,handgun legislation,and statewide suicide rates

BackgroundWithin the US, veterans exhibit an elevated suicide rate, with firearms serving as the most common method. Research has demonstrated that several state laws regulating handgun ownership are associated with lower suicide rates.MethodPublically available databases were utilized to extract relevant data.ResultsStatewide veteran population rates (per 100,000) predicted overall suicide rates, firearm suicide rates, and the proportion of suicides by firearms. Furthermore, the association between veteran population and overall suicide rate was largely explained by the elevated proportion of suicides by firearms in states with higher veteran populations. Lastly, results demonstrated states without handgun legislation in place exhibited higher veteran populations.ConclusionsFindings indicate veterans may impact statewide suicide rates through their propensity to use firearms as their method and that the tendency for veterans to live in states without handgun legislation may exacerbate this phenomenon.     

The supply and demand for guns to juveniles: Oakland’s gun tracing project

In response to Oakland, California’s high level of gun violence affecting young people, the East Oakland Partnership to Reduce Juvenile Gun Violence, a citywide collaboration, was formed in 1997. In 1999, the Partnership established the Oakland Gun Tracing Project to develop evidence-based policy recommendations aimed at reducing the supply of and demand for gun acquisition among urban youth. The advocacy project involved gathering, analyzing, and using police record and gun sale/registration data to inform policy and practice. Such data were collected for all gun crimes committed in Oakland, California between 1998 and 1999 in which a juvenile was either the suspect or the victim. The 213 cases involved 263 juveniles of which 170 were suspects/perpetrators and 93 were victims. Suspects as well as victims were predominantly male and African American. The 213 cases involved 132 recovered guns. Only 55% of the cases were traced to a federally licensed dealer. Three-quarters of the guns were purchased near Oakland, California. Successful traces, defined as the ability to identify federally licensed dealers and initial purchasers, were completed on only 52 of the 132 guns, demonstrating systemic tracing difficulties. Data gathered for the project was used to advocate for numerous policy changes. Recommended policy strategies include initiating a comprechensive gun tracing program so police can track all secondary sales, new laws requiring federal handgun registration which would track ownership changes, required reporting of stolen firearms, and providing effective intervention services to all juveniles the first time they enter the criminal justice system. Preliminary findings were reported in a presentation at the American Public Health Association Annual Meeting in Atlanta, Georgia, October 2001.     

From gunstore to smoking gun: tracking guns that kill children in North Carolina

Purpose

This study reviews the epidemiology of pediatric firearm deaths in North Carolina and estimates the time from the retail sale of guns to their involvement in pediatric firearm deaths.

Methods

The authors reviewed autopsy reports for all children 0 to 14 years of age that died of firearm-related injuries in North Carolina from January 1999 through December 2002. Data obtained included demographic information, firearm type, and manner of death. Data from the Bureau of Alcohol, Tobacco and Firearms, which traced guns involved in crimes and determined the time elapsed from purchase to their involvement in a crime (ie, time-to-crime were also reviewed).

Results

During the study period, 40 children died of firearm injuries. Mean age was 7.6 years. Handguns were responsible for the majority of deaths (59%) followed by shotguns (27%), rifles (10%), and undetermined cause (10%). Most deaths were homicides (67%) followed by unintentional death (18%), suicide (13%), and undetermined cause (2%). Most crime guns (76%) were purchased legally, and many (40%) had a time-to-crime of less than 3 years.

Conclusions

Legally purchased firearms pose a significant threat to children in North Carolina. A more restrictive approach to the sale of handguns is a logical approach to reducing pediatric firearm-related deaths in the United States.     

兔坐骨神经高速弹丸震荡伤后腰段脊髓运动神经元及胶质细胞凋亡规律

目的：探讨坐骨神经高速弹丸震荡伤后腰段脊髓运动神经元及胶质细胞凋亡规律。方法：65只大耳白兔分为正常对照组，高速弹丸震荡伤组（震荡伤组）和功能伤组，震荡伤组致伤靶点为兔右大腿外侧坐骨神经体表投影线中点，切割伤组在同一水平切断右坐骨神经，应用DNA电泳，原位末端标记法（TUNEL）染色和流式细胞仪进行细胞凋亡定性定量检测。结果：震荡伤组伤后2周运动神经元数明显减少，伤后1，2周，可见TUNEL阳性运动神经元及胶质细胞，DNA电泳出现凋亡梯形带，流式细胞仪检测可见亚二倍体峰，震荡伤组伤后1，2周，细胞凋亡百分比分别为10．6％和26．4％，切割伤组仅在4周时有少量阳性运动神经元，结论：与切割伤组比较，震荡伤组细胞凋亡发生早，数量多，凋亡是坐骨神经高速弹丸震荡伤后运动神经元数量减少的主要机制。     

一种输尿管战创伤动物模型的建立

目的 建立一种输尿管战创伤动物模型.方法 使用自行研制的火器弹片伤制造模具,分别对模型建立组9条比格犬的一侧输尿管制造火器弹片伤,并于30 min后直接清创缝合.分别于术后40、80、120 d进行静脉肾盂造影、肾图检查;并分批处死比格犬,取出输尿管行组织形态观察,初步评估该模型的可行性和有效性.结果 模型建立组9条比格犬,术后损伤侧出现肾盂、输尿管积水并逐渐加重;肾脏分浓缩率比值(未损伤侧/损伤侧)逐渐增高,半排时间比值(未损伤侧/损伤侧)逐渐下降,差异有统计学意义;损伤侧输尿管吻合处瘢痕增生、狭窄.结论 该输尿管火器弹片伤比格犬模型,损伤侧术后出现肾盂、输尿管积水并逐渐加重;损伤侧较之未损伤侧,肾小管的浓聚功能下降,肾脏的半排时间延长;损伤侧输尿管吻合处狭窄、瘢痕纤维排列紊乱.证明它是一种可行、有效的输尿管战创伤动物模型.     

寒冷干燥环境下羊肢体枪伤骨折钢板内固定的实验研究

目的 观察寒冷干燥环境下羊肢体枪伤骨折后不同时间采用钢板内固定的疗效. 方法 选取新疆绵羊15只,处于-25℃寒冷干燥环境下3 h后,以7.7式手枪枪击一侧小腿,致胫骨中段骨折.根据伤后处理时间的不同,将其分为6、12和24 h处理三组,每组5只羊,分别于伤后6、12、24 h行伤口清创、骨折钢板内固定,然后通过大体观察伤口愈合情况.采用单因素方差分析比较三组伤口愈合时间;通过X线片及病理观察骨折愈合情况. 结果 术后15只动物伤口愈合均良好,术后早期三组均有个别动物伤口出现红肿,12 h和24 h处理组个别动物伤口有少量分泌物,但均未形成感染.6、12、24 h处理组的伤口愈合时间分别为(5.20±0.44)、(5.60±0.55)、(6.00±0.71)d,三组之间差异无统计学意义(F=2.40,P>0.05).X线片示三组骨折对线对位均良好,术后12周骨折线基本消失.术后12周病理观察三组均无骨髓炎表现,骨生长良好.术后6 h处理组骨重建与骨塑形最快,24 h处理组最慢. 结论 寒冷干燥环境下肢体枪伤后6～24 h,伤道清创后骨折可以采用钢板内固定、一期闭合伤口,且越早越好.